Provider Demographics
NPI:1821433863
Name:GALLAGHER, ERIC DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIEL
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-1718
Mailing Address - Country:US
Mailing Address - Phone:802-257-0341
Mailing Address - Fax:802-251-8435
Practice Address - Street 1:17 BELMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-251-8611
Practice Address - Fax:802-251-8419
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0014856207X00000X, 207X00000X
ORMD184417207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6704439Medicaid